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A Survey of Advanced Life Support Practices in the United States

Published online by Cambridge University Press:  28 June 2012

Robert F. Lavery ,
James Doran ,
Bartholomew J. Tortella  and
Ronald P. Cody
Robert F. Lavery
Affiliation:
Division of Trauma and Emergency Medical Services, The New Jersey Trauma Center, University Hospital and the University of Medicine and Dentistry of New Jersey, Newark, N.J.
James Doran
Affiliation:
Department of Environmental and Community Medicine, Robert Wood Johnson Medical School—UMDNJ, Piscataway, N.J.
Bartholomew J. Tortella*
Affiliation:
Division of Trauma and Emergency Medical Services, The New Jersey Trauma Center, University Hospital and the University of Medicine and Dentistry of New Jersey, Newark, N.J.
Ronald P. Cody
Affiliation:
Department of Environmental and Community Medicine, Robert Wood Johnson Medical School—UMDNJ, Piscataway, N.J.
*
University Hospital Emergency Services, 150 Bergen Street, C-384, Newark, NJ 07103USA
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Abstract

Study Objective:

A national survey was conducted to determine the sponsorship of emergency medical services (EMS) projects, composition of EMS advanced life support (ALS) teams, types of medications and equipment carried, and procedures approved for use by EMS systems in the United States.

Methods:

A mail survey was sent to 211 training supervisors of EMS services across the United States in 1989. The survey requested demographic and service-related information, including types of EMS sponsorship, composition of ALS teams, medications and equipment carried, and procedures which personnel have been trained to use. Medications carried were correlated with advanced cardiac life support (ACLS), the American College of Emergency Physicians (ACEP) recommended drug lists, and with the sponsoring agency.

Results:

One-hundred seventy (70%) survey forms were returned. The major providers of ALS in the United States are fire departments (36%), followed by private providers (26%), hospitals (22%), and local governments (16%). The most common ALS team composition was two paramedics followed by one paramedic and one emergency medical technician (EMT). Most ALS services carry all of the recommended ACLS medications; a much smaller percentage carry all of the drugs recommended by ACEP. Fire department based ALS units carried the least number of medications; hospital-based ALS units carried the highest number of medications. Combined, over 80 different medications were carried by the services responding to the survey.

Conclusion:

The use of ACLS drugs and procedures are well-established nation-wide; less accepted are the medications recommended by ACEP. While over 80 different medications are carried by the EMS systems that responded to this survey, only a small fraction have been investigated in the prehospital setting.

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 7 , Issue 2 , June 1992 , pp. 144 - 150
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1992

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References

1. Criley, JM, Lewis, AJ, Ailshie, GE: Mobile emergency care units. Adv Cardiol 1975;15:9–24.CrossRefGoogle ScholarPubMed
2. Friedman, E: Emergency services: Growing discipline comes of age. Hospitals 1979;April 1:85–97.Google Scholar
3. Grace, WJ: Out-of-hospital care for cardiac emergencies: prevention of sudden death in the community. Heart & Lung 1974;3:733–735.Google ScholarPubMed
4. Harvey, JC: The Emergency Service Systems Act of 1973. JAMA 1974;230:1139–1140.CrossRefGoogle ScholarPubMed
5. Lewis, RP, Stang, JM, Fulkerson, PK et al. : Effectiveness of advanced paramedics in a mobile coronary care system. JAMA 1979;241:1902–1904.CrossRefGoogle Scholar
6. Nolte, CT, Grace, WJ: Life-support units. Heart & Lung 1974;3:779–784.Google ScholarPubMed
7. Pascarelli, EF, Katz, IB: Planning and developing a prehospital mobile intensive care system in an urban setting. Am J Pub Health 1978;68:389–393.CrossRefGoogle Scholar
8. Pepe, P: The past, present and future of emergency medical services. Prehospital and Disaster Medicine 1989;4:47–49.CrossRefGoogle Scholar
9. Rockwood, CA, Mann, CM, Farrington, JD et al. : History of emergency medical services in the United States. J Trauma 1976;16:299–308.CrossRefGoogle ScholarPubMed
10. Rose, LB: The Oregon coronary ambulance project: An experiment. Heart & Lung 1974;3:753–755.Google ScholarPubMed
11. Webster, AC: Evolution of emergency cardiac care in Canada. Canadian Med Assoc J 1977;117:1383–1386.Google ScholarPubMed
12. Pantridge, JF: Prehospital coronary care. Br Heart J 1974;36:233–237.CrossRefGoogle ScholarPubMed
13. Pepe, P, Bonnin, MJ, Mattox, KL: Regulating the scope of EMS services. Prehospital and Disaster Medicine 1990;5:59–63.CrossRefGoogle Scholar
14. Shuster, M, Chong, J: Pharmacologic intervention in prehospital care: A critical appraisal. Ann Emerg Med 1989;18:192–196.CrossRefGoogle ScholarPubMed
15. Cales, RH: Advanced life support in prehospital trauma care: An indication in search of an intervention. [editorial] Ann Emerg Med 1988;17:651–653.CrossRefGoogle ScholarPubMed
16. Stewart, RD: “Things are seldom what they seem…” [editorial] Ann Emerg Med 1989;18:1015–1017.CrossRefGoogle Scholar
17. American College of Emergency Physicians: Prehospital advanced life Support Skills, Medications and Equipment. Ann Emerg Med 1988;17:1109–1111.CrossRefGoogle Scholar
18. American College of Emergency Physicians: Guidelines for Emergency Medical Services Systems. Ann Emerg Med 1988;17:742–745.CrossRefGoogle Scholar
19. EMS in the United States: A Survey of providers in the 200 most populous cities. JEMS 1990;14:50.Google Scholar
20. Braun, O, McCallion, R, Fazackerly, J: Characteristics of mid-sized urban EMS systems. Ann Emerg Med 1990;19:536–546.CrossRefGoogle Scholar
21. Keller, RA, Forinash, M: EMS in the United States: A survey of providers in the 200 most populous cities. JEMS 1990;15:79–80.Google ScholarPubMed
22. Albarran-Sottello, R et al. : Textbook of Advanced Cardiac Life Support. American Heart Association, Dallas: American Heart Association, 1988.Google Scholar
23. Heller, MB, Duda, J, Maha, MJ et al. : Prehospital use of nifedipine for severe hypertension. Am J Emerg Med 1990;8:282–284.CrossRefGoogle ScholarPubMed
24. Eitel, DR, Meador, SA, Drawbaugh, R et al. : Prehospital administration of inhaled metaproterenol. Ann Emerg Med 1990;19:1412–1417.CrossRefGoogle ScholarPubMed
25. Emerman, CL, Shade, B, Kabincancek, J: Controlled trial of the prehospital use of isoetherine for acute asthma. Ann Emerg Med 1990;19:459. Abstract.Google Scholar
26. Syverud, SA, Borron, SW, Stoerer, JR et al. : Prehospital use of neuromuscular blocking agents in a helicopter ambulance program. Ann Emerg Med 1988;17:236–242.CrossRefGoogle Scholar
27. Deleo, BC: Endotracheal intubation by rescue squad personnel. Heart & Lung 1977;6:851–854.Google ScholarPubMed
28. Stewart, RD, Paris, PM, Winter, PM et al. : Field endotracheal intubation by paramedical personnel: Success rates and complications. Chest 1984;85:341–345.CrossRefGoogle ScholarPubMed
29. Jacobs, LM, Berrizbeitia, LD, Bennett, B et al. : Endotracheal intubation in the prehospital phase of emergency medical care. JAMA 1983;250:2175–2177.CrossRefGoogle ScholarPubMed
30. O'Brien, DJ, Danzl, DF, Hooker, LM et al. : Prehospital blind nasotracheal intubation by paramedics. Ann Emerg Med 1988;17:487. Abstract.Google Scholar
31. Shea, SR, MacDonald, JR, Gruzinski, G: Prehospital endotracheal tube or esophageal gastric tube airway: A critical comparison. Ann Emerg Med 1985;14:102–112.CrossRefGoogle ScholarPubMed
32. Auerbach, PS, Geehr, EC: Inadequate oxygenation and ventilation using the esophageal gastric tube airway in the prehospital setting. JAMA 1983;250:3067–3071.CrossRefGoogle ScholarPubMed
33. Silvast, T: Initiation of resuscitation in patients with prehospital bradyasystolic cardiac arrest in Helsinki. Resuscitation 1990;19:143–150.CrossRefGoogle Scholar
34. Hedges, JR, Syverud, SA, Dalsey, WC et al. : Prehospital trial of emergency transcutaneous cardiac pacing. Circulation 1987;76:1337–1343.CrossRefGoogle ScholarPubMed
35. Eitel, DR, Guzzardi, LJ, Stein, SE et al. : Non-invasive transcutaneous pacing in prehospital cardiac arrest. Ann Emerg Med 1987;16:531–534.CrossRefGoogle Scholar
36. Lawerence, DW, Lauro, AJ: Complications from IV therapy: Results from field-started and emergency-department started IVs compared. Ann Emerg Med 1988;17:314–317.CrossRefGoogle Scholar
37. Mattox, KL, Bickell, W, Pepe, PE et al. : Prospective MAST study in 911 patients. J Trauma 1989;29:1104–1111.CrossRefGoogle ScholarPubMed
38. Aprahamian, C, Gessert, G, Bandyk, DF et al. : MAST-associated compartment syndrome (MACS): A review. J Trauma 1989;29:549–555.CrossRefGoogle ScholarPubMed
39. Yamamoto, LG: Cellular telephone communication between hospitals and ambulances. Am J Emerg Med 1988;6:35–38.CrossRefGoogle ScholarPubMed
40. McGuire, TJ, Pointer, JE: Evaluation of a pulse oximeter in the prehospital setting. Ann Emerg Med 1988;17:1058–1062.CrossRefGoogle ScholarPubMed